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NPI Code Detail

MEDICARE: FALL FORWARD WELLNESS CENTER

MEDICARE: FALL FORWARD WELLNESS CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LCAS-20838OTHERNCNORTH CAROLINA PROFESSIONAL PRACTICE BOARD

General Provider Information

NPI Number : 1487270674
Entity Type Code : Organization
Provider Name (Legal Business Name) : FALL FORWARD WELLNESS CENTER
Provider Business Mailing Address
First Line : 12709 CALDWELL RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28213-3811
Country : US
Telephone Number : 704-968-2466
Fax Number :
Provider Business Practice Location Address
First Line : 12709 CALDWELL RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28213-3811
Country : US
Telephone Number : 704-968-2466
Fax Number :
Authorized Official
Title or Position : BUSINESS DEVELOPMENT MANAGER
Name : MS. DENISE MELENDEZ
Credential :
Telephone Number : 954-857-8479
Provider Enumeration Date : 06/23/2020
Last Update Date : 06/23/2020

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Directions to “FALL FORWARD WELLNESS CENTER ” Practice Location

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